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General NPI Number Information
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NPI Number | 1184870800
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Entity Type | Organization
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Legal Business Name | ALTERNATIVE LIFE SOLUTIONS COUNSELING PLLC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 2458 E 11TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4236
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Country | US
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Telephone | 432-582-2444
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Fax | 432-582-2449
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Provider Business Mailing Address
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Address Line | PO BOX 12462
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City | ODESSA
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State | TX
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Zip | 79768-2462
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Country | US
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Telephone | 432-582-2444
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Fax | 432-582-2449
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Authorized Official
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Title or Position | OWNER
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Name | MR. RONALD SCOTT MARTIN
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Credential | LPC-S LSOTP
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Telephone | 432-582-2444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 20187
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14764
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License Number State | TX
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